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General NPI Number Information
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NPI Number | 1649600651
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Entity Type | Organization
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Legal Business Name | WEI YAN TAN PHYSICIAN. P.C.
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Dates
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Enumeration Date | 11/13/2013
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Last Update Date | 11/22/2013
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Provider Practice Location Address
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Address Line | 281 SYOSSET WOODBURY RD
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City | WOODBURY
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State | NY
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Zip | 11797-1205
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Country | US
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Telephone | 917-334-2922
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Fax |
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Provider Business Mailing Address
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Address Line | 281 SYOSSET WOODBURY RD
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City | WOODBURY
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State | NY
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Zip | 11797-1205
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Country | US
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Telephone | 917-334-2922
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | WEIYAN TAN
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Credential | MD
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Telephone | 917-334-2922
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 225855
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License Number State | NY
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